Oleson, Jacob

AbstractObjectiveTo evaluate tumor control and facial nerve outcomes after gross‐total (GTR), near‐total (NTR), and subtotal resection (STR) of sporadic vestibular schwannomas (VS).Data SourcesPubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched in August 2021 through inception following PRISMA guidelines.Review MethodsEnglish language articles reporting tumor control and facial nerve outcomes of adults (≥18 years) with NTR and STR of VS were evaluated. Study characteristics, demographics data, tumor characteristics, type of surgical intervention, and outcome measures on tumor control and facial nerve function were collected. Pooled relative risk (RR) estimates for tumor recurrence and facial nerve outcomes were calculated and stratified by extent of resection.ResultsFrom an initial search of 2504 articles, 48 studies were included in the analysis. When comparing 1108 patients who underwent NTR to 3349 patients with GTR, the pooled RR of recurrence in the NTR cohort was 2.94 (95% confidence interval [CI] 1.65‐5.24, P = .0002). When comparing 1016 patients who underwent STR to 6171 patients with GTR, the pooled RR of recurrence in the STR cohort was 11.50 (95% CI 6.64‐19.92, P < .0001). Estimates for risk of tumor regrowth for less‐than‐complete resection are presented. There was no elevated risk of adverse facial nerve outcome (defined as House‐Brackmann grade III and above) in each category of extent of resection compared to GTR.ConclusionExtent of resection predicts risk of tumor recurrence/regrowth following microsurgical resection. Favorable facial nerve outcome should be weighed against the increased risk of regrowth and the potential need for further treatment.

Motivated by the paucity of high‐quality stillbirth surveillance data and the spatial analysis of such data, we describe the pattern of stillbirth events as a step toward increased understanding of risk factors which can better guide future measures to mitigate these events. A challenge in such an analysis is that some mothers experience stillbirth events from independent pregnancies within a defined study period. To account for these dependencies, we parameterize our model to include a maternal contextual effect and broaden the appeal of Bayesian Poisson point process modeling to quantify excess stillbirth risk while considering a form of a log‐Gaussian Cox process. In the presence of extra unobserved spatial variation in risk, we demonstrate a pragmatic methodologic strategy to model the risk surface in relation to covariates and that there is a variance‐bias trade‐off associated with the use of a maternal contextual effect. We applied our strategy to the spatial distribution of stillbirth in Iowa during the years 2005–2011 using data obtained from an active, statewide public health surveillance program. We identified areas of excess risk for further investigation based on model components that captured important features of the data.